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Tijdschrift voor Psychiatrie 54 (2012) 11, 965 - 972

Short report

The challenge of staging developmental disorders

R.J. van der Gaag, P.J.M. van Wijngaarden-Cremers, W.G. Staal

background On the basis of our current knowledge, developmental disorders can be divided into the following stages: stage 0: normal variation, stage 1: simple disorder of moderate severity, stage 2: complicating co-morbidity and/or harmful background circumstances, and stage 3: serious disorder with harmful background circumstances.
aim To describe the current views on prognostic aspects of staging from a developmental perspective.
method The study is based on a critical review of the relevant literature.
results The current division into stages is still insufficiently predictive, partly because development is a flexible process with risks, chances and second chances. All psychiatric disorders are in essence developmental disorders that arise in the course of development as a result of the interaction between predisposition and background circumstances. As from the very first meiosis the hereditary predisposition is subject to influences in the womb environment. The forming of networks in the brain, the distribution of neurotransmitters and the neurological profile are influenced by the genetic potential for chances and risks and are all a result of interactions. This complicated developmental history raises questions about the specificity of current clinical syndromes.
conclusion In time there is likely to be a much more accurate staging system. This will come about if, as a result of the analysis of large pooled databases, it becomes possible to make a better assessment of the relative risks of genetic configurations, brain connections, stress regulation in the brain, neuropsychological profiles and behavioural and emotional forms of expression in the light of the interactions that occur with the aforementioned background circumstances.

keywords adhd, autism, developmental psychopathology, staging